In that time, I’ve seen seven doctors in three states, a naturopath, a few acupuncturists, a Reiki practitioner and a handful of massage therapists. I’ve had 11 intrauterine inseminations, taken oral medications and given myself injections to coax my eggs, done one round of minimal-stimulation in vitro fertilization (IVF), popped supplements and brewed herbs, given up caffeine and alcohol (at times), switched to mostly organic food, modified my exercise habits, quit a big job and moved to a new state in part to reduce stress, and undergone innumerable blood tests to tell me what my hormones are up to that day, that hour.

When I started I was 37. In August I’ll be 42 — the age when fertility clinics don’t want to know you (not that you’re too popular at 39, 40 or 41, either).

And after all that, I find myself seriously considering another round of IVF this summer. Why?

That’s tough to answer. When you spend so much time, energy and money trying to have a baby (I’velaid out about $30,000 as of this writing; one more round of IVF would raise it at least another $15,000), it’s easy to lose perspective.

Once you’re on the fertility hamster wheel, in pursuit of the dream shared by most of the human race — to be a parent to your biological child — there’s no one who can tell you it’s time to get off of it. Americans are, after all, raised on the notion that with hard work, you can do anything — except, apparently, turn back the clock on your ovaries.

Like many women, I waited too long to start trying to get pregnant, hoping that I’d find a great man to marry and do things the conventional way. But when I hit 35 and Mr. Right wasn't in sight, after much internal debate I decided to pursue matters on my own. I not only truly wanted to be a mother, I knew I’d be a good one and any baby entrusted to me would be lucky.

Now, four years into my journey to conceive, an anniversary — even a sad one — seems a good time for reflecting on the lessons I’ve learned so far, including the things I’d do differently.

Find a doctor you believe inMy first doctor in Santa Monica, Calif., was thoughtful and attentive, with an Ed Harris sort of look and a kindly, if somewhat passive, approach. The fertility practice he was part of had wonderful nurses, a sleek, minimalist aesthetic and a reputation for a celebrity clientele.

My second doctor was in Arizona, a blowhard with pictures of his success stories (i.e., babies) insensitively plastered on the walls of his tacky Southwest-décor office. (Please don’t make infertile women look at photos of other people’s kids, I wanted to scream.) After keeping me waiting for 45 minutes, his first words on hearing my history with the L.A. doc were that I should have done a single round of IVF instead of the seven inseminations — I would have been more likely to get pregnant, he said. Very helpful, I thought, sinceI can’t actually turn back time. I disliked him immediately.

But who do I think was the better doctor for me? Probably Dr. Arizona. The truth is, in retrospect, I should have had a doctor who was much more aggressive. Though I had no history of any sort of physical problem, I believe I should have started drugs much sooner, and my L.A. doctor should have tried to make a case for IVF rather than simply swallow my (admittedly defiant) declarative that I would not do anything high-tech.

In short, I might have benefited from someone I didn’t just like — but someone I truly believed in.

Never say neverI said I’d never do IVF. Never. That was when I was 37, when it wasn’t so much that I had hope as that I had no doubt that this would work. It wasn’t even a question in my mind.

I was as healthy as they come, so when the inseminations with anonymous sperm didn’t make me pregnant month after month, I was perplexed, but it never occurred to me that it wouldn’t happen at all. But that prospect gradually became more and more real. Talks with doctors turned to going on injectable drugs to grow more follicles for inseminations, then IVF.

It took me a couple more years, but last fall I did a modified version called minimal-stimulation IVF (fewer drugs, much lower cost) with a doctor in New York. Now, nine months later, I find myself researching a regular round of IVF for this summer, complete with turbo-charged drugs. I’m also debating paying another $5,000 for preimplantation genetic diagnosis in an attempt to help determine if any embryos are viable.

Don’t tell everyoneI am very lucky. I have a lot of friends and a not a small number of acquaintances and colleagues. Over the past four years, pretty much everyone I know knows that I’m trying to have a baby and have been unsuccessful.

So when I did that first round of IVF, I told everyone. I had some notion that their collective energy would be the tipping point into getting me pregnant. I just knew this was going to work so I didn’t spend much energy thinking about how I’d deliver the news that my two lovely embryos hadn’t, in fact, turned into a viable pregnancy. But they didn’t, and I had dozens of concerned, good-hearted folks wanting to know what happened, and then offering their condolences.

The thing is, though, that people don’t always say the thing that you really want to hear right then. In the middle of your despair you’ll probably hear five well-meaning versions of “Have you thought about adoption?” and a dozen variations on “I know a woman who was [fill in any age from 40 to 55] when she got pregnant for the first time.”

I do understand that others see the obvious next step as adoption. I have sent away for the information packets from agencies (they sit unopened), and I've put meetings about international adoption in my calendar (I’ve never gone).

The truth is, I haven’t felt a call, for lack of a better word, to adopt. If I'm being honest, I also feel so worn out from the last four years that the idea of embarking on another byzantine, capricious process where I'd have to expose my whole life to more scrutiny — especially after experiencing the discrimination of doctors who refused to treat me because I'm a single woman — is anathema. Then there is the $25,000 or so I'd have to come up with.

These aren't noble reasons and I know that I may change my mind down the road. I have a fantasy where I pull a Jolie-Pitt, skipping the onerous adoption process mere mortals face, and someone hands me an orphan from Darfur or some other godforsaken place and says, "Love him, care for him, give him a good home," and I do, in a heartbeat. But that, of course, is not how it works and just now I don't have the wherewithal to start all over.

Start soonerIf I had it to do over again, I’d have gotten checked out by a doctor at age 35, which was my original plan. But I was living in London at the time, being driven into burnout by a 70-hour-a-week job. (If only I’d known at the time that infertile people in the U.K. are entitled to a free round of IVF!)

By the time I was settled in a more laid-back job in L.A., two years had passed. When I started trying to get pregnant, most of my worry was reserved for the kind of mother I’d be and how I’d afford to raise a child. Little did I know that 20 percent of people diagnosed with infertility get the wholly unsatisfying designation of “unexplained infertility.” Sorry, we don’t know what’s wrong with you. That ended up being me.

In truth, the anecdotes you hear about women driven to tears by hormone shots and relationships rent asunder from the strain of on-demand sex and unwanted childlessness are just the publicity shot of infertility’s toll. They’re just a small part of what happens, especially when all the shots and blood tests and invasive procedures don’t get you any closer to being a parent.

The reality that you will never have a child of your own, like any life-changing loss, is only made tangible over a lifetime of not having what you so deeply wanted.

Then there are the days (most, in fact) when I have more perspective — I’m not living in Kabul or Baghdad, after all — and I find a way through the morass of “why me?”

I start to consider a life where I’m not a mother and won’t be. It seems doable. I remember that there’s a lot about my life that I love; I would never bring a child into a life I wasn’t mostly happy with. But then I realize that I’m not quite there yet, not ready to stop.

So I will likely do one more round of IVF in August. I think it may empty out my coffers, both financial and emotional, once and for all. But I don’t expect the peace that some people say they get once they’ve tried everything they can.

I’ve only found less peace in the past four years, not more, and I don’t expect the end to bring me more.